Title: Economic Access to Anti-retroviral (ARV) Prescription Drugs and Adherence to ARV Guidelines for African American Medicaid Enrollees with HIV-Disease in South Carolina Abstract: South Carolina ranked fifth in the U.S. with regard to rate of new cases of HIV infection reported in 1998. Of these 76 percent were black, and one quarter were infected through heterosexual contact. The proportion of new HIV cases in South Carolina who are women of child- bearing age increased from 23 percent in 1990 to 33 percent in 1997; of these more than 85% are black. The extent of under-treatment of black Medicaid HIV patients in South Carolina is not known because Medicaid does not have a separate mechanism for managing drug therapy for its HIV-infected clients. Even though Medicaid HIV patients are entitled to receive the recommended drugs, in fact this does not always happen. South Carolina is largely a rural poor state where many black HIV patients receive their care from primary care providers who are not familiar with the latest ARV guidelines. A disproportionately high proportion of the 30 percent of SC's population who are black are dependent on Medicaid for access to medical care and prescription drugs This project will identify the magnitude of this problem and its health and economic consequences, and begin to develop solutions. This study will 1) use the Office of research and Statistics (ORC) to identify black Medicaid patients with expected for individuals adhering to ARV guidelines; 2) use the ORS to group patients with no ARV bills by primary care provider ID number, and patients with ARV bills by pharmacy ID number and share and provide blinded data to the PI; 3) estimate quality of life and budget impacts of potential improvements of adherence to ARV guidelines for SC Medicaid patients; 4) collect information and make evidence summaries of approaches from SC and other states which have proven successful in increasing HAART drug uptake rates and/or ARV adherence for black PVAs in rural/poverty areas; and 5) provide blinded data from Step 2, along with data managers, medical leaders and others from the eleven regional AIDS Care Consortia to develop culturally-sensitive plans for optimizing use and adher4ence to ARV for BLACK Medicaid PVAs in SC; and 6) We will monitor Medicaid billing data for two years and provide data based summaries feedback to Medicaid and community leaders to continuously improve the system for facilitate access and adherence to ARV guidelines for SC black Medicaid PVAs.